Healing people, families and communities with Medication and with - PowerPoint PPT Presentation

Healing people, families and communities with Medication and with Traditional Medicine Grace Katie B Bell M MSN RN-BC C CA CARN P PHN Telewell I Indian Health MAT P Project

The speaker has no commercial ties to report.

Learning Objectives 1. Describe the unique challenges of addressing the Opioid Epidemic in AI/NA communities. 2. Explain the importance of integrating Cultural and Traditional Recovery principles in Tribal Clinic Medication-Assisted Treatment (MAT) programs for treating Opioid Use Disorder and all Substance Use Disorder. 3. Understand and explain the medical and psychosocial complexities of providing care for native patients diagnosed with OUD.

The Spirit of Our Work • Commitment to offering best practice, evidence based care to those in our Native communities suffering with opioid use disorder • Cultural and Tradition-centered Recovery • Trauma-sensitive and resilience-focused care • Harm Reduction and Abstinence-Directed • Restoring wellness to families and communities

California Tribal Maps

Tribal Medication Assisted Treatment Project – a brief overview California Consortium for Urban Indian • Health (CCUIH) – MAT Champions, Narcan Distribution, Regional Opioid Coalitions. California Rural Indian Health Board • (CRIHB) – MAT Champions, Narcan Distribution and Regional Coalitions CIOSC – California Indian Opioid Safety • Coalition – a collaborative effort by CRIHB and CCUIH supporting the many projects, education and events

Tribal Medication Assisted Treatment (TMAT) Project – a brief overview Telewell Behavioral Medicine Indian Health MAT Project – Tele-MAT care, • MAT program consulting and Cultural Traditions Integrated with MAT care. Two Feathers – Native American Family Services – Developing a Tribal • Youth and Family Services Consortium . Evaluating culturally – appropriate service modalities. Focus on Suicide Prevention. UCLA Integrated Substance Abuse Programs – Tribal Project Echo – • monthly MAT case review with Tribal clinics throughout California. USC Keck School of Medicine – Producing a Tribal MAT Needs • Assessment and evaluation of Tribal MAT Projects.

Challenges • Tight-knit, isolated communities • Stigma – within the walls of care, within families and within community attitudes • Over-prescribing of pain meds still occurring in some regions • Co-occurring stimulant use and alcohol use disorders • Despair • Historical trauma

The Solutions • Whole person, whole community care – building strong multi-disciplinary programs for people with opioid use disorder. • Access – no wrong door! • Balance of Culture and modern medicine • Understanding and responding to unique challenges • Cultivating and Integrating Traditional Healing and Medicine

Medications for Addiction Treatment • Buprenorphine/naloxone - partial agonist opioid - normalizes the brain • Methadone –a full agonist opioid – an option for patients requiring daily dosing and also a treatment preference for some of our patients • XR-Naltrexone – long-acting antagonist for alcohol and opioid use disorder, decreases cravings for alcohol and blocks opioids • Naloxone – short-acting antagonist reverses overdoses – saves lives Medica edicatio ions st stabil iliz ize e and d buy y tim ime f e for p psy sych choso socia cial, whole-pe person n care a and nd restoration n of r relations nshi hips ps and nd welln llness.

Medicine • Culture, Tradition and Native Identity • The sacred ways – honoring and ceremony • Restoring of language • Caring for Youth and for Elders • Spirituality – connects all of life • Historical Resilience

The Solution: Recovery and Wellness Culture and Tradition White Bison /Red Road to Wellbriety • Restoration of wellness • 12 Step support Culture and Identity • Behavioral Health • Life Directions • Restored Relationships • Bell 2019

Cultural Humility • Cultural Humility focuses on self-humility rather than a state of knowledge or awareness particularly to a culture which one does not belong. • Cultural Humility is cultivated from a place in the human heart and the understanding that we do not know, we cannot ever fully know the impact of genocide and centuries of injustice…and our work, wherever it takes us, is to advocate for justice from where we stand.

Offering Technical Assistance to Tribal Clinics a Telewell Service • Site visits to Tribal clinics across the state • MAT Program Needs Assessments • Patient pathway of care, best practices, staff workflows, policies and procedures • Multi-disciplinary team building and all-staff trainings • “curbside consults” – emails, texts, calls regarding patient care

Chapa-De Indian Health Medication Assisted Treatment “ ...buprenorphine has literally saved my life, it has saved my son’s life, it is my saving grace...” ~ G. G. – a lifelong native patient at Chapa-De is now 2 ½ years abstinent in our MAT program. Homeless for years, she is now living a full life with a stable home, a great job and a happy 12 year old son.

Shoulder to Shoulder We Heal Together “ Humans are vulnerable and rely on the kindnesses of the earth and the sun; we exist together in a sacred field of meaning.” ~ Joy Harjo, Muskogee Creek – first Native Poet Laure reate of United States Katie B Bell w with Earl L Lent SUD counse selor at To Toiyabe Clin inic ic, Bis ishop, C CA.

POST QUIZ • Name two unique challenges in addressing Opioid Epidemic in AI/Communities. • True or False: White Bison and the Wellbriety Movement accepts and supports Medication- Assisted Treatment as part of Substance Use Disorder recovery. • Briefly explain how historical and intergenerational trauma impacts Native patients with Opioid Use Disorder.

References Tipps, R. et al The Opioid Epidemic in Indian Country. 2018. The Journal of Law, Medicine and Ethics. 46 (2) • https://journals.sagepub.com/doi/abs/10.1177/1073110518782950?journalCode=lmec Dasgupta, Naburan PhD, MPH, et al. The opioid Crisis – No easy fix to its Social and Economic Determinants. AJPH 2018, Vol 108, No. 2 • https://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.2017.304187 Yellow Horse Brave Heart, M. The Historical Trauma Response Among Natives and Its Relationship with Substance Abuse: A Lakota • Illustration. 2011 Journal of Psychoactive Drugs vol 35 https://www.tandfonline.com/doi/ref/10.1080/02791072.2003.10399988 Ehler, C. et al Measuring historical trauma in an American Indian Community Sample: Contributions of substance dependence, affective • disorder, conduct disorder and PTSD. 2013. Drug and Alcohol Dependence 133(1) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3810370